Discovered by the Sumerians in 3400 BC, opium's strong pain relieving and sedative properties caused the drug to gain popularity worldwide.
The pharmaceutical company Bayer first synthesized heroin from morphine in 1874, marketing it in 1898 as a non-addictive cough suppressant, as well as a treatment for morphine addiction.
Heroin was later discovered to metabolize into morphine, and all opium derivatives (except in prescription medications) including heroin were eventually prohibited.
The drug has been illegal in the US since 1924 and is classified a Schedule I controlled substance, meaning it has a high potential for abuse with no currently accepted medical use. Currently, heroin abuse in the US is at epidemic proportions.
Here are some key points about heroin. More detail and supporting information is in the main article.
- The number of heroin users in the United States has increased from 90,000 in 2006 to 669,000 in 2012.
- Pure heroin is an extremely potent white powder with a bitter taste.
- The brain becomes conditioned by the repeated dopamine rush caused by heroin.
- According to the Centers for Disease Control and Prevention (CDC), the heroin death toll quadrupled in the decade that ended in 2013.
- More than 75% of high school heroin users turned to heroin after first being introduced to prescription painkillers.
- Heroin addiction accounts for 18% of admissions for drug and alcohol treatment in the US.
- The toxic effects of heroin can be reversed with a short-acting opioid receptor antagonist known as naloxone.
What is heroin?
Heroin is an opioid drug that relieves pain and slows body functioning. It is a partial synthetic that combines morphine and diacetyl acid. It can look like a white or brown powder, or black tar. Users snort, smoke, or inject the drug just under the skin (popping or chipping), or into a muscle.
Heroin can take the form of a white powder and can be injected using a syringe.
Its effects can be felt almost immediately, and the duration of action is 4-5 hours. No matter how it is delivered into the body, heroin is highly addictive.
Heroin binds to and activates specific receptors in the brain called mu-opioid receptors (MORs). When MORs are activated in the reward center of the brain, they stimulate the release of the neurotransmitter dopamine, causing a sensation of pleasure. Individuals intoxicated with heroin appear sedated or nod off, have slurred speech and pinpoint pupils.
Once it reaches the US, local distributors and dealers each "cut" the heroin with additional substances, varying the purity of a batch anywhere from 20-70% heroin. Additives used include a variety of water-soluble and sometimes lethal chemicals such as powdered milk, sugar, baking soda, laundry starch, brick dust, floor cleaner and even rat poison.
Every batch of heroin is unique and potentially far more dangerous than one expects. Recently, heroin has been found to be laced with fentanyl, an opiate that is nearly 100 times more potent than morphine and 50 times more powerful than heroin.
Because of the impurities and unpredictable purity, both the experienced and novice user can easily use more than intended, leading to complications or death from overdose.
Heroin street names
- Hell dust
- China white
- Aunt Hazel
- Brown sugar.
Extent of heroin use
Despite its sale and use being illegal in most parts of the world, heroin use is growing as a problem in many cities. Higher quality and lower priced heroin is available throughout the nation, affecting both suburban and rural communities.
Heroin use is on the rise among young adults aged 18-25. Individuals in this age group seeking treatment for heroin abuse increased from 11% of total admissions in 2008 to 26% in the first half of 2012. According to the 2013 National Survey on Drug Use and Health, an estimated 24.6 million (8%) Americans aged 12 or older were current (past month) illicit drug users.
After ingesting heroin, the user's pleasure center fires all at once, producing a pain-free, anxiety-free surge of euphoria (a rush) accompanied by a warm, comfortable feeling. The rush is then followed by drowsiness or nodding.
Other side effects of use may be nausea, vomiting, severe itching, heavy limbs, constipation, clouded mental function and slowed vital signs.
Health risks of heroin
Heroin use is associated with multiple health risks - including death from overdose - making it one of the most dangerous illicit drugs an individual can use.
Heroin carries a high risk of producing psychological (craving) and physical dependence over a short period of time. Because of the repeated use of the drug, changes have occurred in the body, resulting in a withdrawal syndrome if the drug is suddenly stopped. Physical dependence does not necessarily mean a person is addicted.
Tolerance occurs when more of the drug is required to achieve the same initial effect.
Heroin is highly addictive and overdosing on the drug can be fatal.
Repeated heroin use often results in addiction - a chronic relapsing disease that goes beyond physical dependence and is characterized by uncontrollable drug-seeking behavior despite harmful and negative consequences. Once a person becomes addicted to heroin, seeking and using the drug becomes their primary purpose in life.
Death from overdose
A heroin overdose is characterized by slow and shallow breathing, blue lips and fingernails, clammy skin, seizures, coma, and if unrecognized and left untreated, eventual death. If an opioid overdose is quickly identified, the medication naloxone can reverse it. Naloxone works by rapidly binding to opioid receptors, displacing the heroin and putting the individual into immediate withdrawal.
Symptoms of withdrawal include:
- Muscle and bone pain
- Nausea and vomiting
Major withdrawal symptoms peak between 24-48 hours after the last dose of heroin and subside after about a week. However, some people have shown persistent withdrawal signs for many months.
Heroin use during pregnancy can result in neonatal abstinence syndrome (NAS), causing the baby to become dependent along with the mother. Symptoms include fever, irritability, seizures, slow weight gain, tremors, diarrhea, vomiting and potentially death.
NAS requires hospitalization and treatment with medication that is gradually tapered off until the baby adjusts to being opioid-free.
Additional possible medical complications stemming from heroin use include:
- HIV infection
- Sexual dysfunction
- Irregular periods in females
- Perforated nasal septum
- Scarred veins
- Bacterial infections of the blood vessels and heart valves
- Abscesses and soft-tissue infections
- Organ damage
- Allergic reactions
- A weakened immune system.
Treatments for heroin
Methadone is a common form of treatment for heroin addiction available through outpatient treatment programs.
There are different approaches to heroin misuse and addiction treatment. However, treatment initially starts with the detoxification process. The process can be carried out on an inpatient or outpatient basis to assist the individual both physically and mentally as the body adjusts to the absence of the drug.
Prescription medications clonidine, ondansetron, and hydroxyzine may be used to lessen the discomfort of withdrawal. There are several pharmacological treatment options for long-term addiction therapy. Effective medications include methadone, Suboxone and Vivitrol.
Methadone is a slow-acting opioid agonist taken orally every 24 hours at an individualized dose that is just enough to prevent withdrawal while not producing euphoria. Methadone has been used since the 1960s to treat heroin addiction and is still an excellent treatment option for some individuals in recovery. Methadone is only available through approved outpatient treatment programs.
Suboxone is a formulation containing buprenorphine (partial opioid agonist) and naloxone (an opioid antagonist). Buprenorphine relieves drug cravings without producing the "high" or dangerous side effects of other opioids and acts as a deterrent to injecting. It is taken by mouth, usually in sublingual form (placed under the tongue).
Vivitrol is administered as a once a month injection. Vivitrol is the opioid antagonist naloxone. It blocks the high if an individual uses heroin while on it.
There are many behavioral treatments for heroin addiction available in both residential and outpatient settings. Individuals are taught techniques such as mindfulness and stress-coping skills to modify their behavior related to their drug use.
Relapse is unfortunately common, making some form of long-term - and in some cases even life-long - treatment necessary for many individuals.
Recent research published in The New England Journal of Medicine reveals that an increasing number of prescription opioid abusers are also using heroin.
Heroin users who do not benefit from conventional addiction treatments should receive heroin-assisted therapy. This is according to a Canadian professor, whose views were recently published in The BMJ.
Heroin is a dangerous, potent opioid analgesic that is highly addictive. It is a Schedule I controlled substance with no accepted medical use. For those with opioid use disorder to prescription painkillers, the availability and affordability of heroin make it an attractive substitute for hard-to-obtain pills.
Long-term use of heroin is associated with multiple health risks, and because illicitly obtained heroin varies widely in purity, it is easy to fatally overdose. Naloxone is an available medication that can reverse an overdose.
Although it is a difficult drug to stop due to the extremely uncomfortable withdrawal and the association with addiction, there are several treatments available that make sustained recovery from heroin abuse and misuse possible.